摘要
目的探讨粒子放疗对前列腺癌患者骨髓、肝和肾功能的影响。方法随机选取前列腺癌患者76例,其中接受光子放疗23例(光子放疗组),重离子放疗25例(重离子放疗组)、质子重离子放疗28例(质子重离子放疗组)。各组根据治疗方案再分为单纯放疗和同步内分泌治疗2个亚组。通过所有患者治疗前、后的白细胞(WBC)计数、淋巴细胞绝对值(LYMPH#)、血红蛋白(Hb)、血小板(PLT)计数判断骨髓功能抑制情况;检测所有患者治疗前的白蛋白(Alb)、总胆红素(TB)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、肌酐(Cr)和尿素水平。采用5.0版常见不良事件评价标准(CTCAE)进行评级。比较15例光子放疗同步内分泌治疗患者和13例重离子放疗同步内分泌治疗患者治疗前后的肝、肾功能指标检测结果。结果光子放疗组、重离子放疗组和质子重离子放疗组治疗前WBC计数、Hb、PLT计数、TB、ALT、尿素差异均无统计学意义(P>0.05),3组之间Alb、AST、Cr、LYMPH#差异均有统计学意义(P<0.05)。单纯重离子放疗组LYMPH#Ⅰ级者所占比例[100%(12/12)]高于单纯光子放疗组[50%(4/8)]和单纯质子重离子放疗组[50%(4/8)](P=0.015)。重离子放疗同步内分泌治疗组LYMPH#Ⅰ级者所占比例[100%(13/13)]高于光子放疗同步内分泌治疗组[33%(5/15)]和质子重离子放疗同步内分泌治疗组[35%(7/20)](P=0.002)。重离子放疗同步内分泌治疗组和质子重离子放疗同步内分泌治疗组HbⅠ级者所占比例[100%(13/13)、100%(20/20)]均高于光子放疗同步内分泌治疗组[73%(11/15)](P=0.048)。光子放疗同步内分泌治疗患者治疗后血清ALT水平高于治疗前(P=0.005),血清Cr水平低于治疗前(P=0.026),血清Alb、TB、AST、尿素水平治疗前后差异均无统计学意义(P>0.05)。重离子放疗同步内分泌治疗患者治疗前、后Alb、TB、ALT、AST、Cr、尿素差异均无统计学意义(P>0.05)。结论无论重离子放疗是否同步内分泌治疗,其骨髓功能抑制程度均低于光子放疗和质子重离子放疗;且对肝、肾功能的抑制作用低于光子放疗同步内分泌治疗。
Objective To investigate the influence of particle radiotherapy on bone marrow,liver and kidney functions in prostate cancer patients.Methods A total of 23 prostate cancer patients undergoing photon radiation(photon radiation group),25 prostate cancer patients undergoing heavy ion radiation(heavy ion radiation group),28 prostate cancer patients undergoing proton heavy ion radiation(proton heavy ion radiation group)were enrolled,and according to treatment plans,each group was classified into simple radiotherapy and synchronous endocrine therapy subgroups.White blood cell(WBC)count,the absolute value of lymphocytes(LYMPH#),hemoglobin(Hb)and platelet(PLT)count were determined before and after treatment for all prostate cancer patients,in order to reflect bone marrow function suppression.The levels of albumin(Alb),total bilirubin(TB),alanine aminotransferase(ALT),aspartate aminotransferase(AST),creatinine(Cr)and urea were determined before treatment.Common Terminology Criteria for Adverse Events(CTCAE)version 5.0 was used.The liver and kidney functions before and after treatment in 15 patients undergoing synchronous endocrine therapy and photon radiation and 13 patients with synchronous endocrine therapy were determined and compared.Results There was no statistical significance in WBC count,Hb,PLT count,TB,ALT and urea in photon radiation group,heavy ion radiation group and proton heavy ion radiation group before treatment(P>0.05).There was statistical significance in Alb,AST,Cr and LYMPH#among the 3 groups(P<0.05).The proportion of LYMPH#gradeⅠpatients after heavy ion radiation was higher(100%,12/12)than those after photon radiation(50%,4/8)and proton heavy ion radiation(50%,4/8)(P=0.015).The proportion of patients with LYMPH#gradeⅠafter synchronous endocrine therapy of heavy ion radiation(100%,13/13)was higher than that of photon radiation(33%,5/13)and proton heavy ion radiation(35%,7/20)(P=0.002).After the synchronous endocrine therapy of heavy ion radiation and proton heavy ion radiation,the proportions of Hb gradeⅠwere 100%(13/13,20/20),which was higher than that of photon radiation(73%,11/15)(P=0.048).After photon radiation combined with endocrine therapy,serum ALT level was higher than that before treatment(P=0.005),and serum Cr level was lower than that before treatment(P=0.026).There was no statistical significance in serum Alb,TB,AST and urea levels before and after treatment(P>0.05).There was no statistical significance in Alb,TB,ALT,AST,Cr and urea before and after heavy ion radiation combined with endocrine therapy(P>0.05).Conclusions The degree of bone marrow function suppression of heavy ion radiation is lower than that of photon radiation and proton heavy ion radiation,whether it is synchronous endocrine therapy or not.The suppression effect on liver and kidney functions is lower than that of photon radiation combined with endocrine therapy.
作者
俞琪
王砚春
郭林
卢仁泉
YU Qi;WANG Yanchun;GUO Lin;LU Renquan(Department of Clinical Laboratory,Cancer Hospital Affiliated to Fudan University,Department of Oncology,Shanghai Medical College,Fudan University,Shanghai 200032,China)
出处
《检验医学》
CAS
2023年第5期430-434,共5页
Laboratory Medicine
基金
国家自然科学基金面上项目(82072876)。
关键词
粒子放疗
质子重离子放疗
重离子放疗
光子放疗
骨髓功能
肝功能
肾功能
Particle radiotherapy
Proton heavy ion radiotherapy
Heavy ion radiotherapy
Photon radiotherapy
Bone marrow function
Liver function
Kidney function
作者简介
俞琪,男,1989年生,技师,主要从事临床检验工作;通信作者:卢仁泉,E-mail:lurenquan@126.com。
